Abstract 14486: Application and Procedure-Related Outcome of Early Invasive Strategy in Non-ST Segment Elevation Acute Coronary Syndrome in Relation to the Pre-Procedural Risk Assessment

IntroductionEarly invasive strategy (EIS) for patients with high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) are recommended in recent guidelines; however, a discrepancy exists between the real-world application of EIS and estimated patient risk. Further, little is known about the potential adverse effects associated with EIS.AimsWe aimed to examine the extent of EIS utilization in patients with NSTE-ACS, according to their predicted mortality risk, and evaluate the association between EIS utilization and procedure-related adverse outcomes.MethodsUsing a prospective, multicenter Japanese registry, we evaluated 3,124 patients with NSTE-ACS who underwent percutaneous coronary intervention. Patients were categorized into quartiles according to the National Cardiovascular Data Registry (NCDR) CathPCI risk score. Multivariable analyses were performed to determine predictors of EIS utilization. Additionally, in-hospital outcomes, including acute kidney injury (AKI) were compared between patients treated with and without an EIS.ResultsOverall,EIS utilization was observed in 82.1% (N=2,436) of patients with NSTE-ACS. The median NCDR CathPCI risk score was 22 (IQR;14-32) with an expected 0.3-0.6% in-hospital mortality. Patientswith higher age, peripheral artery disease, or absence ofelevated cardiac troponin levelwere less likely to be treated with EIS, regardless of predicted mortality risk. EIS utilization was associated with increased risk of AKI (adjusted OR;1.70, 95% CI;1.22-2.38), particularly for low-risk patients.ConclusionsIn a contemporary Japanese registry, EIS was utilized in a majority of the patients with NSTE-ACS, regardless of severity. EIS utilization comes at the cost of increased AKI development risk; the risk-benefit profile in lower-risk patients should be assessed appropriately.